Empowered-Services

inspirations

Corporate Office

8101 SW Nyberg St. Suite: 217 Tualatin, OR, 97062

Phone Number

503-855-3581

Customer Care Intake

Let's build a care team around what matters.

Tell us a bit about you and the person needing support. A Care Coordinator will be in touch within 1–2 business days with next steps — no commitment required.

Confidential & secure
Response in 1–2 business days
All 36 Oregon counties
No pressure · No commitment
Service availability may vary by county.
Step 1 of 5

About you

The person filling out this form. We'll use this to reach you.

Share your preferred language and we'll do our best to match you with a coordinator or interpreter who can help.

Step 2 of 5

About the person receiving support

If that's the same as you, feel free to skip the name and jump to location.

Feel free to use just a first name or initials for privacy.

Helps us match the right Care Coordinator to your area.

Step 3 of 5

Current services & timing

Help us understand where you are today. It's OK to be unsure — we'll help you figure it out.

Note: Empowered Services is a Medicaid/ODDS-funded agency. We do not currently offer private-pay services.

From your CDDP, Brokerage, or referring agency.

Check all that apply. We'll tailor our response.

Who would you like as your Empowered Choice caregiver?
If you already have someone in mind, share their information below — a family member, friend, or trusted supporter you'd like to become your paid caregiver. Haven't decided yet? Feel free to leave this blank and we'll discuss options on our call.
Primary caregiver

Each preferred caregiver will need to complete a background check and onboarding before starting paid work. We'll walk them through the process.

Step 4 of 5

Support profile

Optional — but every box you check helps us match the right Direct Support Professional faster and more accurately. Skip any group that doesn't feel right, or select "Not sure yet." Most people finish this section in under 2 minutes.

What areas may support be needed in?
Check all that apply. It's okay to choose "not sure" if you don't know yet.
What type of support may be helpful?
Check all that apply.
Is support needed soon?
Check all that apply.
Are there any important matching needs?
Check all that apply. This helps us pair the right person with the right fit.
Anything else we should know?
Is there anything else that would help us better understand the support needed? Specific goals, preferences, accommodations, concerns — whatever feels important to share.

0 / 2000 characters

Step 5 of 5

Almost done.

Last couple of details — and you're done.

First name alone is fine. We'll make sure they get credit for the referral and can say hello on our call.

Ready when you are. Your form goes directly to our Care Coordination team, and you'll receive a confirmation email within minutes. We'll reach out within 1–2 business days.

What happens next

  1. Instant confirmation
    You'll see a confirmation page right after submitting, and a confirmation email will arrive in your inbox within a few minutes. If you don't see it, check your spam folder.
  2. Care Coordinator reaches out
    Within 1–2 business days, using your preferred contact method.
  3. Discovery conversation
    A 20–30 minute call to understand goals, preferences, and what makes this person them.
  4. Match with your team
    We introduce the right Direct Support Professional — someone who fits your life, not just your paperwork.

Your information is safe with us.

Information submitted through this form is used by Empowered Services' Care Coordination team to review your request, follow up, and coordinate appropriate next steps. Intake information is handled through authorized systems, including Empowered Services' Google Workspace environment covered by a Business Associate Agreement. We do not sell, trade, or share your information with third parties for marketing.

503-855-3581 info@empowered-services.org Privacy policy
Need help with this form? Call (503) 855-3581